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PSNC responds to funding cuts with 'clinical' vision

Phase one of the proposals will involve the move to electronic repeat dispensing

PSNC's proposals include support for asthma patients and making the majority of pharmacists independent prescribers

The Pharmaceutical Services Negotiating Committee (PSNC) has responded to the government challenge to create a more "clinically focused" pharmacy service on 6% less funding with a three-phase action plan.

PSNC released the plan, which includes proposals to increase community pharmacy's medicines optimisation role and electronic repeat prescribing, because the government had "no specific proposals" to broaden the sector's clinical role, it said on Tuesday (February 9).

It would “of course be unaffordable” for pharmacists to offer all the services set out in the plans if the government continues with its plans to cut the global sum for England by 6% in October, PSNC stressed.

The negotiator pledged to develop the proposals in line with feedback from the Department of Health and NHS England, which both called for a "clinically focused community pharmacy service" in an open letter last December announcing the funding cut.

PSNC told C+D that phase one of the plan was about developing existing ways of working. This includes the development of a "care package", which will involve "regular" medicines optimisation support and "MUR-type conversations" with patients.

Minor ailments 

It will also include a minor ailments service, inhaler checks and the "default" use of electronic repeat dispensing for medicines needed on a long-term basis. PSNC also suggested that pharmacists should centrally record any interventions they made on prescriptions.

Phase two of the plan would involve conducting assessments on patients with COPD, asthma and those at risk of falls, and the roll-out of an accreditation equivalent to healthy living pharmacy (HLP) status. In phase three, PSNC set out plans for "the majority" of community pharmacists to be qualified as independent prescribers.

PSNC could not confirm exact timescales for the proposals, but told C+D that phase one could be rolled out more quickly than phases two and phase three, which would be developed "over time".

The negotiator is also working with other pharmacy bodies to "coordinate a campaign against the aspects of the [government's] proposals which will have an adverse impact on patient services and access to community pharmacies," it said. 

Phase one

  • Community pharmacy "care package"
  • Central recording of prescription interventions
  • Up to six national public health campaigns a year
  • Inhaler technique coaching
  • Medicines reconciliation  

Phase two

  • Assessing patients with COPD and asthma
  • Conducting frailty and falls assessments
  • An annual "MUR-type review"
  • The roll-out of an accreditation equivalent to healthy living pharmacy status         

Phase three

  • Phase 1 and phase 2 will continue
  • Pharmacists will manage long-term conditions. 
  • The majority of pharmacists will be independent prescribers 

     

What do you think about PSNC's proposals?

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52 Comments

Angela Channing, Community pharmacist

I find this all very strange....  Doctors respond to funding cuts with strike action. Pharmacists say.... hang on,  we'll do MORE!!!  

Chris Pharmacist, Community pharmacist

The PSNC should recommend its members oppose these cuts in the strongest possible terms. If it doesn't then the PSNCs position should surely be untenable. Meanwhile, the silence from the multiples remains deafening, probably still plotting how to pass these cuts straight onto their staff without affecting shareholder dividends and senior management bonuses...community pharmacy, a profession 'led' by coporate yes-men (and women).

Angela Channing, Community pharmacist

And with the new national min/living wage, that means locums and pharmacist employees will probably suffer.   (Received an email at the weekend offering a 30k salary for a 45 hr week. Interestingly saw an ad for Aldi Assistant manager for 30k! Similar hours but obviously no pharmacy law and ethics to follow!)

James Spiral, Community pharmacist

I am sure the PSNC must already be aware that 50% of the establishment payment will go in october and the other 50% will be gone in april 2017 and yet all they come up with is more freebies. I can see this plan being the basis for a new contract even more disastrous than the one in 2005.

Bapi Patel, Work for a health/commissioning consultancy company

I find some of the postings on here unbelievable. No matter what our leaders do they cannot win. This particular writing has been on the wall for a generation. Any industry that thinks its curent form is the best possible should have a chat with coopers or wheelrights. 

If you don't think a large proportion of dispensing can be carried out by automats then you should go and talk to the guys (and there are more of them each week) who have one installed. They don't save much money but they create time and opportunity.  

Seems to me we have a choice; support a move to a service based environment that sees Pharmacy as a part of the health system or remain the same and fight for our share of dispensing against organisations who will act like fish factories and hoover up every prescription they can find.

Our patients value us not the robot.

Still its funny to read the majority of these posts - its like the band on the Titanic playing as the ship is sinking and at the same time arguing about who will pay them... 

 

Shaun Steren, Pharmaceutical Adviser

With respect I find your post unbelievable. Most community pharmacists would like nothing more than to get out the dispensary and have no nothing to do with the dispensing process. To sit in the relaxing and protective environment of a consultation room whilst the constant grind, stress and chaos of dispensing is carried out by somebody else, is nothing short of nirvana for a pharmacist. However, what your extremely short-sighted post negates to mention is that this  'ideal world' version of events has been promised for the last ten years and absolutely nothing has happened. Instead the pharmacist has been expected to carry out both roles without a single penny of investment being made towards your fantasy version of clinical pharmacy. So where is the massive scale investment in robotics? Where is this massive investment in information technology? Where is this massive investment in portable bio marker testing technology? Where is this army of ACTs? Where are all the changes to law that will ensure pharmacists are not held responsible for other people's dispensing errors or OTC sales? Where are the masses of research papers that empirically prove the cost-effectivness of pharmacist based interventions?  Where is the commisioning of all these extremely well funded and evidence based clinical services? Where is this enshrined partnering with GPs to make everything joined-up?  Where is the complete removal of barriers to entry that would allow the best pharmacists to innovate and compete based on patient value?............ And please don't anybody patronise employee pharmacists by answering with management b*ll*cks speak about 'going forward' and  'new paradigms' - answer in clear language basing every single statement on empirical evidence. Thank you. 

 

Chris Pharmacist, Community pharmacist

Over 10 years since the new pharmacy contract and still a very minimal and patchy 'extended role'. Pharmacists would embrace and adapt but there is no new role. GPs oppose it, the NHS doesn't want to pay for it and both don't understand what we are capable of and how we could positively contribute to patients health and the NHS... thats the reason for our concerns regarding loss of supply role.

London Locum, Locum pharmacist

Funny post.

London Locum, Locum pharmacist

Funny post.

Bapi Patel, Work for a health/commissioning consultancy company

 

 

Meera Sharma, Community pharmacist

While I agree that the landscape of community pharmacy needs to change to adapt with the external changes, why are our leaders not recognising the supply function? If it really is that robotic and irrelevant, stop all pharmacies dispensing prescriptions, MDS and emergency supplies for a day. I'd love to see the knock-on effect on surgeries, urgent care centres and hospitals! It is a critical, core part of community pharmacy. And yet, this very role is being threatened by a 6% cut in funding, loss of establishment payment and threat of closure. How are we responding to this? - Let's have a 3-tier services plan! Is this not the 2005 contract just re-worded?? Exactly how many community pharmacies are going to be able to do an IP course, given that their very existence is under threat, despite having invested in their business following the 2005 contract? What assurances do they have that this is not another fallacy? We should be streamlining all our services to remove the word "free" from most of it, instead of offering to "add" even more to it with less funding. How is this helpful to any patient? The mind boggles!

Shaun Steren, Pharmaceutical Adviser

The supply function was given away with the 2005 contract. To anybody with any degree of foresight it was game over from that point on. I am surprised at the recent cuts - surprised that they did not happen earlier and in a more substantial way. So when does this strike kick off? 

Tariq Iqbal, Accuracy checking technician

nothing new bend over for Jermey Hunt well Jeremy you have another thing coming and if the PSNC does not challenge him now it will never. in 2005 the new pharmacy contract was voted for on the basis that the LPC stated take it or have it enforced by NHS. Well Junior doctors i salute you take him out 

Farmer Cyst, Community pharmacist

I very much doubt these plans were designed by front-line pharmacists! Unless there's at least two pharmacists on duty at all times in every pharmacy (one checking and the other doing services) then this will not work.

Fiona Roberts, Community pharmacist

PS "NEGOTIATION"C, Why are they not doing their job of negotiating a proper deal for us?

Farm Assistant, Community pharmacist

Because they are crap.

Chris Mckendrick, Community pharmacist

On 2nd Feb C&D reported "PSNC will refuse to negotiate with DH and NHS England until the organisations stop withholding material about their funding plans beyond 2017"

A week later PSNC publish "The Community pharmacy Care Package". Well no one can say PSNC aren't as good as their word - they have refused to negotiate. As a radical alternative strategy they have capitulated on our behalf instead.

No mention of fighting the cuts, just a proposal to offer a heap of work for 6% less, and an implicit acceptance therefore of Alistair Burt's stated ..."1,000 - 3,000 pharmacy closures....multiples better place to cope with cuts (i.e. most closures will be single independents)."

Not "Lions led by Donkeys", lemmings led by jellyfish.

Ebers Papyrus, Pharmaceutical Adviser

Couldn't agree more.

Keith Ridge has with a single letter, alienated, demotivated and further disillusioned community pharmacy. A very responsible direction from the figurehead of the profession? PSNC are basically calling his bluff, if he say's "we could do more", prove it is the response.

Gerry Diamond, Primary care pharmacist

Oh well looks a bit all over the place and the training commitment alone is quite significant, such as the IP course plus specialist training in asthma and copd management, spirometry and more. At leat two years part time..mmmm. Long term plan and the short term cppe courses are ok for cpd but arent substantive like practice nurse training where a six month level 6 module for each long term condition is needed, plus the back up of blod test and more. I think that boat has already sailed as I said many years ago the nurses were ahead of the game....

Interested Person, Manager

We need to offer a suitable alternative to the cuts. Totally agree with PSNC in majoring on the skills of the pharmacist in delivering better outcomes and savings

We all know that the NHS is in financial difficulty so no point in arguing against cuts ( the government has firmly shown their hand with the imposition of the doctors contract!)

Let's show that if given the tools and status pharmacists can help deliver cost efficiencies and savings without the destabilisation of the network

 

 

Brian Austen, Senior Management

The difference is the fight between 'Junior doctors' (that term includes all secondary care doctors below consultant level) and the SoS Health is not over yet. 400 of them left England for foreign shores last month and that figure will be added to month on month. The Consultants will be re-negotiating their contracts shortly and that will be an additional fight! The GPs are still very unhappy about workload pressures; they feel continually dumped on and are considering mass resignation. I'm just waiting for the BMA who are good at representing their members to suggest a collaboration of all doctors. Then the government have 2 choices. Fund changes or reverse policy.

Peter Badham, Superintendent Pharmacist

I can see that the PSNC is trying to build on our strengths., however we already have the NMS service  and the  MUR service which both have serious  issues with the way they were set up. Why do we need to reinvent the wheel?

What we need is 1,000 MURS per pharmacy per year,  and the NMS service to be extended to all new nedication.

These two  services have been shown to add value . Those pharmacists who do not wish to step up will loose their  income stream. Those pharmacists who do , will mitigate some of their  lost profit.

This is the only way we can retain any network of pharmacies

 

Farm Assistant, Community pharmacist

Peter, are you mad? Do you have any idea of the bullying that would happen to make employee pharmacists do 1000 murs a year?  Forget about the income stream, those pharmacists that don't "step up" would lose their jobs. And more to the point the vast majority of murs and nms are a complete waste of time in the first place.

Paul Mayberry, Community pharmacist

MUR. Can I check if you are using your medicines correctly? NMS. Let me explain why you need to take this medicine. Why is that a waste of time? If you aren't going to ask those questions & get paid for asking themt then let a robot in a shed give you your medicines!!!!

 

 

 

London Locum, Locum pharmacist

Peter is a contractor?

Chris Pharmacist, Community pharmacist

MURs and NMS don't 'add value' in any way, shape or form. Patients don't want them, GPs don't want them and neither do pharmacists.

Shaun Steren, Pharmaceutical Adviser

The term 'add value' is used by two sets of people. First, a government official talking on a subject of which they have no expertise or frontline experience. In this case it is a avoidance term - it allows the technically unqualified person to avoid getting into a detailed discussion about the benefit of a policy of which they have no technical understanding. Second, a private company trying to legitimise the profit they make from taxpayers money. In this case it is a diversionary term - it allows a profit seeker to divert the analysis from independent evidence, clinical outcomes, comparative studies and cost-effectiveness.........On this basis, it is easy to understand why it is used so frequently to describe MURs and NMS. 

Farm Assistant, Community pharmacist

As they say in New York.............."money talks, bullshit walks".

Priyesh Desai, Superintendent Pharmacist

PSNC has no idea what the members want,as usual going about the wron way...selling us down the river.We all know the cat M negotiations they did on our behalf

S Morein, Pharmacy Area manager/ Operations Manager

Cat M has been the source of huge excessive profits for contractors. Since its inception in 2005 contractors have benefitted from annual windfalls. PSNC can be criticised for many things but Cat M has been a huge success for the bottom line of all contractors.

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